GHP August 2015

26 | ghp August 2015 years, mobile teledermatoscopy has become one of the most used applications of teledermatology for consulting and educational purposes (10). Redefining the melanoma care process In January 2015, a novel work process using a structured management of melanoma patients was introduced by the Regional Cancer Centre Stock- holm–Gotland in collaboration with the department of Dermatology, Karolinska University Hospital and sev- eral Primary Healthcare Centres. The main objective of this project is to: • Develop a procedure for transfer of melanoma specialist skills • Structure assessments and reports • Educate assessing specialists and referring Gen- eral Practitioners • Support multidisciplinary teams • Address patient data security The telemedicine platform Dermicus™ was selected for the project in order to meet these requirements: Transfer of melanoma specialist skills The General Practitioner (GP) uses mobile teleder- matoscopy to send clinical data and images through a mobile application to the platform. The melanoma specialists analyse the data on the platform and produce a standardised report. Via the secured platform the GP gets access to the diagnosis and the clinical support regarding how to handle the pigmented skin lesion. Structured assessments and reports The platform offers a standardised Digital Derma- toscopy Diagnose Report based on Revised Pattern Analysis (11) including recommendation on diagnos- tic excision by the GP or external surgeon / plastic surgeon depending on size and location of the lesion. The assessment is in a consensus diagnosis setting involving two or more melanoma specialists to yield optimal diagnostic accuracy (9). Education of assessing specialists and referring GPs The e-learning settings of the platform are used in the educational program and certification procedure of the First Line Clinicians (GPs) and the Digital Dermatoscopy Analysers (Specialists). In order to maintain high quality throughout the whole process the GP program includes Total Body Skin Examina- tion since assessment only of the index lesion will risk missing one in three melanomas (12). Supporting multidisciplinary teams The platform offers a teledermatoscopic digital service that provides all specialists (GP, dermatolo- gist, surgeon and pathologist) with the collected data supporting the local melanoma referral process. Patient data security The CE-labelled platform Dermicus™ complies with the requirements for encryption, authentication, secure login and storage of data. In addition, the system meets the Swedish legislation and regulations concerning patient data and the Personal Data Act. Effects of teledermatoscopy Melanoma specialist skills transfer through digital services (teledermatoscopy) to primary care will provide a better selection of suspicious lesions, thereby reducing referrals of benign skin tumours. Melanoma specialist assessments at patients first visit results in fewer unnecessary excisions, associated reduced load on pathology laboratories with improved pathology report response times and decreased healthcare spending. Fast and accurate diagnosis of melanoma provides a high qualitative process and an improved patient experience - ulti- mately early diagnosis saves lives. Dermicus™ The telemedicine platform Dermicus™ was founded 2010 by MD, PhD Johan Heilborn and developed in close collaboration with colleagues at the depart- ment of Dermatology, advised by legal and technical resources at the Karolinska University Hospital. Dermicus™ is delivered by the m-Health Company GNOSCO that offers services for improvement of in- ternal communication, documentation and education within healthcare and hospitals. The Dermicus™ platform has to date delivered more than 4.000 con- sultations and maintains more than 16.000 images. For more information please visit: Future prospectives GNOSCO was recently granted a VINNOVA project (Swedish Governmental Agency For Innovation Systems) for exploring the use of the platform in non-healing wounds – Dermicus Wound™. Non-healing wounds are a worldwide problem within the elderly and the risk increases with age (>65 years). One-fifth of Sweden’s population or about 1,8 million are affected and the disorder is rapidly growing. In a recent report the Swedish agency for health technology assessment and assessment of social services (SBU) concludes that the scientific evidence for the treatment of chronic wounds in the elderly is very limited. The majority of the treatments used today need more research of high scientif- ic quality in order to be properly evaluated (13). Non-healing wounds require significant resources of the healthcare system and account for 2-4% of healthcare budgets. The costs are expected to rise in conjunction with an increased elderly and diabetic population. It is estimated that every fourth person in Sweden will be 65 years or older in 2030 (13,14,15,16,17). Expected effects of Dermicus Wound™ • Supporting the establishment of multidisciplinary teams • Securing a fast and qualitative process for the patient • Delivering continuous education for primary care providers – GPs and nurses • Ensuring a high quality of wound management in community care • Identifying savings for the healthcare budgets GNOSCO Rede ining healthcare digitally industry insight